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CONTRIBUTING TO THE PREVENTION OF CHRONIC

CONDITIONS IN STUDENTS PROGRAM PLAN

Contributing to the Prevention of Chronic Conditions in Students Program Plan

Navjeet Lehal and Andrea Padilla

Pacific Northwest University of Health Sciences

OTH 610: OT Management and Entrepreneurship

Dr. Heather Fritz and Dr. Sara Wyckoff

November 10, 2024

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Students and Chronic Condition Prevention Program Plan Draft

Project Background

There is a need to reduce chronic conditions in our community. PNWU is a medical

school in Yakima, WA that focuses on serving rural and underserved communities. PNWU

offers programs that aim to support the health and wellness of their students. However, there is a

lack of knowledge on how to implement these strategies into their lives. An occupational

therapist (OT) would be beneficial to help individuals structure new habits and routines. The aim

of our program is to contribute to chronic condition prevention in health science graduate

students. One support for the occupational success of our program would be the spaces offered

on campus. The spaces offered are great to use for stress management. For example, there are

wellness rooms on campus where students can meditate or relax, including a gym that is

available to all students. Students have access to all the equipment in the gym which includes

treadmills, free weights and mats for stretching. We will meet in the common spaces in the

MultiCare Learning Center (MLC) facility for general sessions but rent an office in MLC for

more private and one on one sessions. Our group sessions will be twice a week with a maximum

of 20 participants. This will be paid for through donations and a grant offered to PNWU to pay

for OT services. The school also has a wellness program that offers counseling services and

events to support overall wellness. Other resources that the school offers are events like walk

with a future Doc that is run by the physical therapy program. This program organizes walks

with future physical therapists where people from the community or students have the
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opportunity to walk and ask health related questions. OT would work with students to help shape

habits and routines which will enable them to translate the learned information into their life. The

sessions for culinary medicine and walk with a future doc will occur once a month.

The stakeholders from PNWU mentioned it would be beneficial to practice nutritious

eating and to be more active. Dr. Jennifer Fleckenstein (personal communication, 9.19.24), a

professor at the school of physical therapy at PNWU, mentioned sedentary behavior being a

major risk factor in developing chronic conditions. She stated that some ways to combat this

issue are by providing education around physical activity and nutritional recommendations. She

also mentioned self-reflection to be an important aspect of promoting healthy behaviors. Dr.

Briggs Early (personal communication, 9.18.24) said risk factors included a sedentary lifestyle

and poor nutrition options. She mentioned that the person must be motivated to make a change

for themselves, education isn’t enough, and they need to weigh the risk vs the benefit.

Problem Statement

Health science students at Pacific Northwest University of Health Sciences (PNWU) are

at higher risk for developing chronic conditions due to the rigorous course work, financial

hardships that increase stress levels and limit their ability to buy healthy foods, and sedentary

lifestyles. Most people are not meeting the physical or nutritional recommendations. It is crucial

to address these problems to decrease chronic conditions in affected communities such as

Yakima where chronic conditions are common.

Literature Review
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The population we are focusing on is health science graduate students of any age. We are

specifically assessing the lack of movement and poor nutritional habits in those students. The

reason for this is to contribute to the prevention of chronic conditions and help them establish a

healthier lifestyle. Watson et al. (2022) found that the most common conditions in the United

States included obesity, depression, and hypertension (HTN). Additionally, young adults with a

chronic condition had a high chance of smoking and being physically inactive. This means that

those who engage in unhealthy behaviors are more prone to developing a chronic condition

(Watson et al., 2022).

The prevalence of graduate students for science, engineering, and health fields comprises

of 168, 660 students for fulltime U.S. citizens and permanent residents from 2018-2022 (Smith et

al., 2024). Locally, in Yakima, there are 665 graduate students at PNWU for the 2024 fall

semester. The Yakima County the Washington State Department of Health (2022) found that

there were occurrences of chronic conditions including cancer, arthritis, heart disease, diabetes,

and asthma.

Hall (2023) writes about how occupational balance education can lead to being

comfortable and attaining a balanced life. She states it can be done through improved sleeping,

managing stress, being physically active, and eating nutritional meals. Additionally, that leads to

improved routines, being well rested, increased confidence, or participating in preferred

occupations. We want to incorporate a Lifestyle Redesign to help students participate in their

occupations and to promote health and well-being (Pyatak et al., 2022).

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Currently in Yakima there are no programs specifically for graduate students that aim to

contribute to the prevention of chronic conditions. However, there are local programs to support

the general population such as healthy Yakima which partner with MultiCare to encourage

healthy lifestyles. Some of the programs offered are ACT get up and moving, diabetes

prevention, exercise and health classes. Within PNWU there are programs such as culinary

medicine, walk with a future doc, and a wellness program that are available to students. The

culinary medicine program's goal is to familiarize health professions students learning about

healthy food and ingredients by providing hands-on, and culturally relevant training in meal

planning and food preparation. While walking with a future doc provides is more focused on

making movement accessible to all by going on walking and having a conversation. These

classes ultimately aim to prepare students to engage in conversations with future clients about

nutrition and health. The wellness program offers counseling services that can help students if

they need to talk about something or set up activities such as hikes and other events that aim to

improve health. The wellness program also offers reimbursements for gym memberships.

Political factors that may influence the population or program is the universities culture.

PNWU is heavily focused on interprofessional collaboration to help develop students into better

practitioners. This shows that PNWU is open to learning from other disciplines. Economic

factors that may influence the program are that PNWU offers these programs free of charge. This

means that some might not feel as motivated to engage in the programs, especially if they are

already so busy with school and personal life. Environmental factors that may influence the

program are that most services are offered in close proximity to campus. The only downside is

that because PNWU does not offer on campus living, some students live farther away from
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campus and might not be motivated to drive far distances to attend the programs. Additionally, if

a program is done on the weekend, students might choose to go home if traveling from far.

Both Dr. Fleckenstein (personal communication, 9.19.24) and Dr. Briggs Early (personal

communication, 9.18.24) mentioned that having a program with optimal nutrition and exercise

would be good for all the students. Dr. Briggs Early said risk factors for chronic conditions

included a sedentary lifestyle and poor nutrition options. She mentioned that the person must be

motivated to make a change for themselves, education isn’t enough, and they need to weigh the

risk vs the benefit. She said the program would be sustainable if we keep it at 30-minute sessions

once a week. She suggested using an app and requiring a small payment to help with adherence.

We are choosing to focus on Lifestyle Redesign. Lifestyle Redesign is an intervention

framework that draws attention to activities in daily life and health through occupations, habits,

and routines with an emphasis on client autonomy and intrinsic motivation (Pyatak et al., 2022).

Pyatak et al. (2022) writes that that this framework is beneficial to those who are at risk for

chronic conditions. Additionally, lifestyle redesign can be integrated in a variety of settings to

address prevention, health promotion, and chronic disease management which has demonstrated

improvement in health and quality of life. If someone doesn’t want to use Lifestyle Redesign in

person, Mitchell et al. (2023) found that telehealth is feasible and could be effective.

Lifestyle redesign is a program that is being integrated into OT practice. The OT program

at the University of Southern California created programs specifically for college students,

diabetes management, health coaching, mental health, hypertension, sleep disorders, pelvic floor

health, weight management, Parkison's Disease, and many more. Some reviews from college
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students who participated in a lifestyle redesign stated, “I learned things about myself that I

wouldn’t have learned otherwise, like why I do certain things and what gets in my way”.

Similarly, other participants stated that “I don’t know how to describe the huge change you

brought to me in such a short time . . . I have a completely different view of myself” (USC Chan

Division of Occupational Science and Occupational Therapy, n.d.).

Conceptual Framework

The conceptual framework that will inform our approach will be the Model of Human

Occupation (MOHO). This model explains why people engage in certain activities, how routines

are created, and how they perform the activities (Cole & Tufano, 2020). The MOHO does this by

examining four domains which include, volition (motivation), habituation (routines),

performance capacity (abilities), and environment (context). Specifically, for PNWU students the

MOHO will help us understand the student's volition and habituation which influences their

ability to engage and sustain healthy behaviors such as cooking budget friendly meals and

managing stress. This model will also examine the environment such as the resources and spaces

that are offered on campus that will help drive people to engage in healthy occupations.

Performance patterns are habits, routines, roles, and rituals (AOTA, 2020). Performance

patterns create occupational balance which is important for these students because they need to

balance school, work, time with family and friends, and time for themselves. Our main focus

from the performance patterns are habits and routines. We want to create healthy habits and

routines that encourage proper nutritional intake and movement in their daily lives. The goal of

creating sustainable healthy habits and routines is to contribute to the prevention of the risk of

developing chronic conditions while creating and promoting health. Client factors are values,
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beliefs, spiritualty, and body structures (AOTA, 2020). The students' values, beliefs, and

spirituality all affect how well they engage in the program. If they don’t value the program or

have belief that it will work, it is less likely that they will complete it. Additionally, we must

consider what each person's beliefs are about exercise and what that means to them.

This program believes that the graduate healthcare students that it partners with will

become powerful healthcare workers who serve underserved and rural populations. The program

will contribute to the prevention of chronic conditions by allowing healthcare providers to work

with fewer health problems. This is also important so that health care providers can provide

education to their clients on how they can reduce the chances of developing chronic conditions.

Lifestyle redesign is the framework that will inform our approach by using principles

created by the University of Southern California. Lifestyle redesign is defined as, “a framework

that promotes awareness of the relationship between everyday activities and health and guides

people in the process of orchestrating occupations, habits, and routines to enhance health and

wellbeing” (Pyatak, 2022, p. 2)

Anticipated Client Outcomes

We hope to enhance the occupation of being a student through a lifestyle redesign. With

this we aim to:

1. Help the student to achieve occupational balance by completing the activities they wish

to throughout the day by balancing life and school. Being a student requires a lot of time,

making it hard to engage in other occupations that bring meaning to their lives or that

help them meet their health needs.

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2. Create sustainable healthy habits and routines to prevent and or reduce the risk of

developing chronic conditions while creating and promoting health. We aim to help the

students create an exercise routine that embodies their values, beliefs, and spirituality.

3. Increase participation in educational classes about nutrition and wellness allows students

to feel confident in their skills and knowledge of cooking and exercise. Self-efficacy

might help with one's motivation to complete/start a task and to be informed of strategies

that lead to healthier lifestyles.

Our approach to intervention is to contribute to the prevention of chronic conditions at an

earlier age by developing healthy habits and routines. To succeed in the program the students

must engage fully in the process. Participation in educational classes about nutrition and wellness

will aid in discovering strategies to avoid a sedentary lifestyle and how to eat healthy. By

participating they will learn how to engage in healthy behaviors that will help lower the risk of

acquiring a chronic condition. The population of interest is graduate health science students at

PNWU. This will benefit students as they will be able to maintain a healthier lifestyle that will

ultimately lead to a better quality of life. Additionally, there will be healthy healthcare workers

who are able to provide optimal services and provide knowledge on how to contribute to the

prevention of chronic conditions through personal experience.

Program Intervention

A lifestyle redesign intervention through our weekly sessions will focus on orchestrating

habits and routines that might include, goal setting, meal preparation/planning, meditation in

between study sessions, movement breaks, improving time management, organization, and sleep

patterns and lastly modifying environments to enhance focus (Pyatak et al., 2022). By having the
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students incorporate a lifestyle redesign approach, we will be able to provide them with tools to

improve their health while navigating the demands of school with the intention contributing to

the prevention of chronic diseases. For example, we will utilize culinary and wellness resources

for skill building and promoting awareness on how they can choose nutritious foods on a budget

and incorporating relaxation techniques in their daily routines.

Partnering with the culinary medicine program run by Dr. Briggs Early will contribute to

the program by providing the educational component on nutrition at PNWU. This is important to

help students learn the nutritional value of different foods and learn how to read nutrition labels.

They will also learn how to combine foods and portions that will help them reach or closely

reach the daily recommended servings for fruits, vegetables, protein, carbohydrates, and fats.

We can also utilize the school gym at PNWU to work on skills for stress management

techniques such as physical activity. We can watch students perform exercises to ensure that they

are engaging in proper form. We can also discuss breathing techniques for relaxation and other

ways to be physically active that do not require spending time in the gym.
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References

American Occupational Therapy Association. (2020). Occupational therapy practice framework:

Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2),

Article 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Cole, M., B., & Tufano, R. (2020). Applied theories in occupational therapy: A practical

approach (2nd ed.). SLACK.

Hall, M. (2023). Occupational balance education: A prerequisite to healthy habit formation

[Master's thesis, Eastern Kentucky University]. Encompass.

https://encompass.eku.edu/honors_theses/1003

Mitchell, S., Sideris, J., Blanchard, J., Granados, G., Díaz, J., & Pyatak, E. (2023). Telehealth

lifestyle redesign occupational therapy for diabetes: preliminary effectiveness,

satisfaction, and engagement. Occupational Therapy Journal of Research, 43(3), 426-

434. https://doi-org.proxy.pnwu.org/10.1177/15394492231172933

Pyatak, E. A., Carandang, K., Rice Collins, C., & Carlson, M. (2022). Optimizing occupations,

habits, and routines for health and well-being with Lifestyle Redesign®: A synthesis and
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scoping review. The American Journal of Occupational Therapy, 76(5).

https://doi.org/10.5014/ajot.2022.049269

Smith, B., Alldredge, E. E., Arbeit, C. A., & Yamaner, M. I. (2024, March 20). Graduate

enrollment in science, engineering, and health continues to increase among foreign

nationals, while postdoctoral appointment trends vary across fields. National Center for

Science and Engineering Statistics. https://ncses.nsf.gov/pubs/nsf24320

USC Chan Division of Occupational Science and Occupational Therapy. (n.d.). College students.

https://chan.usc.edu/patient-care/faculty-practice/college-students

Washington State Department of Health. (2022, April). Chronic disease profile: Yakima County

(Publication No. 345-271).

https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/345-271-

ChronicDiseaseProfileYakima.pdf

Watson, K. B. (2022). Chronic conditions among adults aged 18─ 34 years—United States,

2019. Morbidity and Mortality Weekly Report, 71.

http://dx.doi.org/10.15585/mmwr.mm7130a3